BackgroundShared decision-making in rheumatoid arthritis (RA) care is a priority among policy makers, clinicians and patients both nationally and internationally. Demands on patients to have basic knowledge of RA, treatment options, and details of risk and benefit when making medication decisions with clinicians can be overwhelming, especially for those with limited literacy or limited English language proficiency. The objective of this study is to describe the development of a medication choice decision aid for patients with rheumatoid arthritis (RA) in three languages using low literacy principles.MethodsBased on the development of a diabetes decision aid, the RA decision aid (RA Choice) was developed through a collaborative process involving patients, clinicians, designers, decision-aid and health literacy experts. A combination of evidence synthesis and direct observation of clinician-patient interactions generated content and guided an iterative process of prototype development.ResultsThree iterations of RA Choice were developed and field-tested before completion. The final tool organized data using icons and plain language for 12 RA medications across 5 issues: frequency of administration, time to onset, cost, side effects, and special considerations. The tool successfully created a conversation between clinician and patient, and garnered high acceptability from clinicians.ConclusionsThe process of collaboratively developing an RA decision aid designed to promote shared decision making resulted in a graphically-enhanced, low literacy tool. The use of RA Choice in the clinical encounter has the potential to enhance communication for RA patients, including those with limited health literacy and limited English language proficiency.

A multiple probe across participants design assessed the effectiveness of an instructional strategy to teach 10 elementary-aged students with moderate intellectual disabilities how to shop for grocery items. Following the intervention, which consisted of in vivo training using constant time delay and simulation training using a pictorial storyboard, 6 students achieved criterion. Two other students' shopping performances improved considerably during training, but the students did not achieve criterion as training was discontinued due to the end of the school year. Maintenance data indicate that the students who achieved criterion retained their skills for 6 weeks, and generalization data indicate that they could shop for the same items in a novel store.

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As the quintessential right-to-education case, Brown v. Board of Education, Topeka, (1954) addressed equality of educational opportunity for all students regardless of race. Recently, the term digital divide has been used primarily to highlight inequities between various social groups with respect to acquiring computers and accessing the Internet. Given how use of these technologies has permeated our society, including our nation's schools, all relevant aspects of the digital divide must be addressed if the spirit of Brown is to be realized. Hence, in this article, the multidimensional meaning of the term digital divide is discussed, as are (a) the effect of this phenomenon as it relates to equality of educational opportunity for all students and (b) ways to address it.

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